Trunk & Postural Control

Question 1

What are the requirements for normal trunk movement?

Answer 1

3 degrees of trunk freedom:

flexion & ext.
right & left lateral flexion
axial rotation

Question 2

Which measures of trunk control have been strong predictors of ADL function?

Answer 2

w/ in 14 days s/p CVA

• trunk control measured using PASS-TC
• Fugl meyer
• barthel index

6 months s/p CVA

• Barthel index
• frenchay activities index (measures IADL)

Question 3

What areas are impacted if trunk function is poor? (consequence’s)

Answer 3

• dysfunctional UE and LE control
• increased risk of falls (limited balance and equilibrium responses, increase weakness)
• potential spinal deformity and contracture
• impaired ability to interact with environment (affect head control and gaze)
• visual dysfunction
• dysphagia
• decreased ADLs
• decreased balance
• decreased tolerance in sitting and standing

Question 4

Principles of normal movement applied to trunk

Answer 4

• normal control dissociation->ROTATION
• rotation is essential for midline control
• postural control of trunk relies on multiple factors (tone, AROM, PROM, pain, strength, perception, etc)

Question 5

Common trunk & postural problems

Answer 5

• posterior pelvic tilt/lumbar spine flexion- sit on a wedge force into anterior tilt
• pelvic obliquity with unequal weight bearing on ischial tuberosities
• kyphosis
• lateral trunk flexion
• rib cage rotation
• head and neck mal-alignment (rotation toward hemi side)

Question 6

General evaluation strategies for addressing trunk problems

Answer 6

• observation of pt movement during daily tasks
• pt. should be shirtless to inspect scapula alignment
• compare quadrants of trunk upper R and L, lower R and L (muscle wasting)
• a slight change in posture can completely change trunk muscle activity and alignment so check in sitting and standing
• trunk should be evaluated in a variety of positions that correspond with occupational tasks

eval areas:

• subjective information
• tone
• ROM
• alignment/malalignment
• functional movement observation
• balance reactions
• patterns of movement

Question 7

Treatment strategies for addressing trunk problems

Answer 7

• trunk AROM and mobilization start with supine, sidelying, sitting and work up to standing
• engage in reaching to activate trunk
• handling to facilitate and strengthen desired muscles and motions
• use movable surfaces (balls, sitting disks, trampoline, etc)
• therapeutic exercise
• environmental adaptations
• therapeutic handling within context of functional task
• incorporate ADLs that require the necessary trunk motions
• adapt environment- if slow or no motor improvement in trunk
  
  • supports, chest straps, pillows, lap trays
  • place objects within reach
  • provide adaptive equipment
  • home modification